CMS Suspends Medical Reviews

Home > Articles > CMS Suspends Medical Reviews

The Centers for Medicare & Medicaid Services (CMS) suspended most Medicare Fee-For-Service medical reviews during the public health emergency period due to the COVID-19 pandemic. This includes pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews, and Recovery Audit Contractor (RAC). No additional documentation requests will be issued for the duration of the public health emergency.

Targeted Probe and Educate reviews that are in process will be suspended and claims will be released and paid. Current post-payment MAC, SMRC, and RAC reviews will be suspended and released from review.

However, CMS said it may conduct medical reviews during or after the public health emergency period if there is an indication of potential fraud.